How many adults live in your household?

How many children live in your household?

Housing

Rent

Own

Homeless

Employment Status

Yes

No

Other

Place of employment

Time of employment at current employer

Number of hours worked each week

Do you currently attend Canyon View Church

Yes

No

How often do you attend Canyon View Vineyard Church?

Never or less than once per year

A few times a year

Once a month

Weekly

How long have you attended Canyon View Vineyard Church?

When was the last service you attended?

How often do you volunteer at Canyon View Vineyard Church?

Never

Once or twice a year

Once a month or more

How often do you give financially to Canyon View Vineyard Church?

Never

Once or twice a year

Occasionally

Regular giver

Have you applied for benevolence in the past?

Yes

No

Please describe the financial situation and how financial assistance improves your situation long-term

What specific life essential needs are you requesting

Dollar amount needed (Or estimate)

Have you applied for assistance elsewhere in the last 6 months? If yes, please list below. (Include assistance from CVVC)

How did you hear about our Benevolence Program?

I am interested in...

Attending/ Serving CVVC

Receiving Salvation/ Baptism

Other

Release of Information
I hereby authorize the release of information to Canyon View Vineyard Church
(CVVC) to receive the assistance I am requesting. I further certify the information I
have stated is true and correct. I understand and give CVVC permission to verify
the information on this application and to discuss my case with other agencies,
businesses, churches, attorneys, individuals, and any others deemed necessary to
verify application information. I understand that all information will remain as
confidential as possible within these entities.

I have read, understood, and agree to the policies above regarding the Release of
Information.

Todays Date

By signing you accept the terms and conditions of this application.